Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Center of the First Hospital of Jilin University, Changchun, 130021, People's Republic of China.
BMC Cancer. 2024 Mar 4;24(1):293. doi: 10.1186/s12885-024-12056-5.
Hepatic proteins, including albumin, prealbumin, and transferrin have been confirmed to be prognostic predictors in various cancers. This study aimed to comprehensively assess the prognostic value of these three serum markers in patients with cancer cachexia.
This multicenter prospective cohort study included 1303 cancer cachexia patients, among whom 592 deaths occurred during a median follow-up of 20.23 months. The definition of cachexia was based on the 2011 international consensus. Concordance index (C-index) and receiver operating characteristic (ROC) curves were applied to compare the prognostic performance. The primary outcome was overall survival, which was calculated using the Kaplan-Meier method generated by log-rank test. A Cox proportional hazard regression model was used to identify independent predictors associated with survival. The secondary outcomes included 90-days mortality and quality of life (QoL).
C-index and ROC curves showed that albumin had the most accurate predictive capacity for survival, followed by transferrin and prealbumin. Multivariate Cox analysis confirmed that low albumin (hazard ratio [HR] = 1.51, 95% confidence interval [95%CI] = 1.28-1.80, P < 0.001), prealbumin (HR = 1.42, 95%CI = 1.19-1.69, P < 0.001), and transferrin (HR = 1.50, 95%CI = 1.25-1.80, P < 0.001) were independent risk factors for long-term survival in cancer patients with cachexia. In subgroup analysis, the prognostic value of low albumin was significant in patients with upper gastrointestinal, hepatobiliary and pancreatic, and colorectal cancers; low prealbumin was significant in colorectal cancer; and low transferrin was significant in patients with upper gastrointestinal and colorectal cancer. All three hepatic proteins were valuable as prognostic predictors for patients with advanced (Stage III and IV) cancer with cachexia. The risks of 90-days mortality and impaired QoL were higher in cachexia patients with low albumin, prealbumin, and transferrin levels.
Low albumin, prealbumin, and transferrin levels were all independent prognostic factors affecting patients with cancer cachexia, especially in patients in the advanced stages. These results highlight the value of routinely checking serum hepatic proteins in clinical practice to predict the prognosis of patients with cancer cachexia.
已证实肝脏蛋白（包括白蛋白、前白蛋白和转铁蛋白）是各种癌症的预后预测因子。本研究旨在全面评估这三种血清标志物在癌症恶病质患者中的预后价值。
这是一项多中心前瞻性队列研究，纳入了 1303 例癌症恶病质患者，中位随访 20.23 个月期间有 592 例死亡。恶病质的定义基于 2011 年国际共识。采用一致性指数（C 指数）和接受者操作特征（ROC）曲线比较预后表现。主要结局是总生存期，通过对数秩检验生成的 Kaplan-Meier 法计算。采用 Cox 比例风险回归模型识别与生存相关的独立预测因素。次要结局包括 90 天死亡率和生活质量（QoL）。
C 指数和 ROC 曲线显示白蛋白对生存的预测能力最准确，其次是转铁蛋白和前白蛋白。多变量 Cox 分析证实，低白蛋白（风险比 [HR] = 1.51，95%置信区间 [95%CI] = 1.28-1.80，P < 0.001）、前白蛋白（HR = 1.42，95%CI = 1.19-1.69，P < 0.001）和转铁蛋白（HR = 1.50，95%CI = 1.25-1.80，P < 0.001）是癌症恶病质患者长期生存的独立危险因素。亚组分析显示，低白蛋白在患有上消化道、肝胆胰和结直肠癌的患者中预后价值显著；低前白蛋白在结直肠癌患者中预后价值显著；低转铁蛋白在患有上消化道和结直肠癌的患者中预后价值显著。所有三种肝脏蛋白均是癌症恶病质伴晚期（III 期和 IV 期）患者的有价值的预后预测因子。白蛋白、前白蛋白和转铁蛋白水平较低的恶病质患者 90 天死亡率和 QoL 受损风险更高。
低白蛋白、前白蛋白和转铁蛋白水平均是癌症恶病质患者的独立预后因素，尤其是在晚期患者中。这些结果突出了在临床实践中常规检查血清肝脏蛋白以预测癌症恶病质患者预后的价值。
